Associate Professor of Radiology Interventional Radiology Fellowship, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
For any patients referred to us with chief complaint of varicose vein or its fear when he or she saw small red vessels on legs, the first thing is to take history, paying attention to history of thrombophlebitis in the patients, and his or her first degrees, history of pain, aching, itching, heaviness and cramp, then do physical examination by inspection, palpation of abnormal veins and looking for any sign of edema, skin discoloration, redness, swelling, color change, active or healed ulcers. Using CEAP classification is necessary to approach the patient, for C0 or C1 disease there is no need for Color Doppler Ultrasound (CDU), but for C2 to C6 disease CDU can be helpful and is recommended. It is mandatory to assess the deep venous system then proceed to evaluation of superficial veins in standing position with and without Valsalva maneuver and after release of muscle augmentation. After the CDU, it is better to map the venous system and mark the abnormal parts and the points of flow reversal that cause varicosity for the patients. It is better to see the problems by inspecting the venous map in one glance.
For C1 disease Sclerotherapy either foam or liquid type can be performed for treatment. For C2 to C6 disease considering the presence of chronic DVT or not or iliac vein obstruction or not, superficial venous reflux may be present. If the patient had deep venous problem or May Turner Syndrome,
they should be treated first.
For treatment of GSV reflux, thermal ablation is nowadays the methods of choice. Other methods that are under development are Glue injection and MOCA. Foam Sclerotherapy and vein surgery are not recommended for these purposes.